Midterm Exam Study Guide for RNSG 1125

Clinical Judgment
  • Definition: Interpretation or conclusion about a patient’s needs, concerns, or health problems, and the decision to take action, modify standard approaches or improvise new ones based on the patient’s response.
    • Antecedents:
    • Sound judgment skills
    • Analytical reasoning skills
    • Awareness of patient & self
    • Creativity/inquisitiveness
    • Sound knowledge base
    • Persistence
    • Attributes:
    • Appropriate response
    • Holistic view of patient and situation
    • Process orientation
    • Reasoning and interpretation
    • Positive Consequences:
    • Improved patient outcomes
    • Evidence-based nursing care
    • Enhanced patient education and nurse-patient relationship
    • Negative Consequences:
    • Unsafe nursing care
    • Failure to rescue patients
    • Breach of professional boundaries
    • Ineffective communication with patients/families
    • Breakdowns in decision-making process
Tanner’s Clinical Judgment Model
  1. Noticing: Perception of the situation, influenced by context, experience, knowledge, ethical perspective, and nurse-patient relationship.
    • Assessment component
  2. Interpreting: Attributing meaning to data through various reasoning methods.
    • Diagnosing/Analyzing component
  3. Responding: Deciding on action and monitoring outcomes.
    • Implementing/Intervention component
  4. Reflecting:
    • In-action: Continuous assessment during care.
    • On-action: Reflective practice after care to evaluate outcomes.
Subjective vs Objective Data
  • Subjective Data: Subject to change, based on what the patient describes.
  • Objective Data: Observable and measurable data collected by the nurse.
Clinical Judgment Measurement Model
  • Models 6 cognitive operations following Tanner's model:
    1. Recognizing cues
    2. Analyzing cues
    3. Prioritizing hypotheses
    4. Generating solutions
    5. Taking action
    6. Evaluating outcomes
Nursing Process
  • Definition: Organized thinking to navigate complex situations; guides assessments and behaviors.
  • AD PIE:
    1. Assessment
    2. Diagnosing/Identifying Problems
    3. Planning
    4. Identifying Interventions
    5. Evaluation
  • Parts of Nursing Diagnosis: Problem, etiology (related to), symptoms (as evidenced by).
  • Planning: Set patient-centered, measurable, and prioritized goals (considering Maslow's hierarchy).
  • Implementation: Carrying out interventions.
  • Evaluation: Reevaluating the problem to see if goals were met.
Clinical Decision Making Models
  • Humanistic Intuitive Approach: Relying on experience for dynamic decision-making.
  • Information Processing Model: Mirrors human thought processes akin to computer processing.
  • Cognitive Continuum Theory: Merges intuitive and analytical cognitive characteristics.
  • REST Framework: Involves moral reasoning processes that guide ethical judgment.
Critical Thinking in Nursing
  • Developable skill requiring situational awareness.
  • Levels:
    • Basic: Trust in experts, based on rules.
    • Complex: Expressing autonomy, analyzing problems.
Medication Orders
  • 7 Rights: Right route, time, drug, patient, dose, documentation, education.
Evidence Based Practice (EBP)
  • Definition: Integrates best current evidence with clinical expertise and patient/family preferences for optimal care.
  • Antecedents:
    • Problem identification
    • Recognition of research's nursing significance
  • Attributes:
    • Replicability, reliability, validity
    • Individualized care
Nightingale’s Influence
  • Set standards for nursing skills and education.
  • Introduced sanitation practices, reducing infection rates.
Research in Nursing
  • Scientific Inquiry: Systematic data collection to develop theories and solutions.
  • Types of Research:
    • Quantitative: Involves measurable data, randomized controlled trials.
    • Qualitative: Explores patient experiences and perceptions using non-numeric data.
  • PICO(T) Questions: Framework for clinical inquiries.
Professionalism in Nursing
  • Definition: Integration of nursing skills with dignity and respect for all individuals.
  • Attributes: Competence, accountability, lifelong learning, advocacy.
Nursing Aims and Health Promotion
  • Aims: Promoting health, preventing illness, restoring health, facilitating coping with disabilities.
  • Healthy People 2030 Guidelines: Strategies to eliminate health disparities and promote well-being.
  • Preventing Illness: Education programs to guide healthy behaviors.
Nursing Organizations & Identity Formation
  • Professional organizations promote standards and advocacy in nursing.
  • DECS: Differentiated essential competencies for nursing.
  • Nursing Hierarchy: Defines roles and delegation in practice.
Safety in Nursing
  • Definition: Protection from harm through effective practices.
  • Attributes: Emphasis on injury-free care.
  • Prevention of Medication Errors: Use of two patient identifiers and barcoding techniques.
Conclusion
  • Emphasize the significance of clinical judgment, evidence-based practice, critical thinking, and professional integrity as central to nursing excellence.